Accurate analogs for bone graft prostheses using computer generated anatomical models

ABSTRACT

Pre-surgical planning for cranial, facial, limb and digit muscular and bone reconstruction includes preparing a computer generated anatomical model for determining a locational position for a dental implant, a surgical bone implant to repair missing bone in the cranium, limbs and digits and to install ear, eye or nose prostheses. The computer generated anatomical model is made from medical imagery and computer aided design. A surgical guide is prepared with oversize holes in registration with analogs for the dental or surgical bone implants to be inserted in the anatomical model. The surgical guide is fitted atop each analog, and bonded to the anatomical model at a predetermined angle of the analog in the anatomy. The surgical guide is removed and attached to the anatomy of a patient for accurate drilling for insertion of the implants or prostheses into the body of the patient.

RELATED APPLICATIONS

This application is a continuation in part of application Ser. No.12/931,705 filed on Feb. 8, 2011, which application is a continuation ofapplication Ser. No. 11/973,747 filed Oct. 10, 2007, now U.S. Pat. No.7,887,327, issued Feb. 15, 2011, which application is a continuation inpart of application Ser. No. 11/449,461, filed Jun. 8, 2006, now U.S.Pat. No. 7,281,927, issued Oct. 16, 2007 and claims priority under 35U.S.C. 120 therefrom, which application is a continuation of applicationSer. No. 10/056,101, filed Jan. 24, 2002, now U.S. Pat. No. 7,059,856issued Jun. 13, 2006 and claims priority under 35 U.S.C. 120 therefrom,which application claims benefit under 35 U.S.C. 119(e) of provisionalapplication Ser. No. 60/316,832 filed Aug. 31, 2001

FIELD OF THE INVENTION

This invention relates generally to the construction of a cranial,facial, limb and digit muscular and bone prosthesis that is attached toan implant in the body of a person.

BACKGROUND OF THE INVENTION

Dental implants are a common treatment for the replacement of a missingtooth or missing teeth. An implant is placed into the bone in a person'sjaw in a variety of fashions and using a variety of systems. The boneand the implant adhere together in a process known as osseointegration,thus enabling a person to have a new tooth or set of teeth held intoposition in the jaw utilizing screws to hold them down.

Many firms manufacture complete systems of dental implants andprosthetic components for subsequent attachment to the implant. In atypical construction, the implant has an axially threaded hole at itstop, that is, the proximal end, near the gum surface. After the implanthas integrated with the bone, the gum of the implant is opened to exposethe tapped hole. Then a transmucosal abutment is attached to the tappedhole of the implant and extends to a level above the gum orsubstantially to the gum surface. The protruding free end of theabutment is constructed for attachment of a prosthesis. For preventingrotation of the prosthesis, the protruding end of the abutment requiresa non-round shape and a hexagon protrusion has been widely used. Arecessed hexagon is also popular with some systems. The abutment alsoincludes a central threaded hole concentric with the threaded hole ofthe implant and extending inward toward the jaw bone.

A false tooth or frame is provided with a hole therethrough, known inthe industry as a chimney, and a non-round recess in its basecorresponds in shape to the protruding non-round cross section for theabutment. Thereby, the crown can be connected to the abutment andrelative rotation between them is prevented so long as critical contoursof the abutment and the recess in the crown are maintained.

To prevent the crown or bridge from lifting axially from the abutment, afinal screw is passed into the chimney opening and engages the tappedhole in the implant by way of the abutment so as to hold the crownaxially to the abutment and to the implant. Thus, the crown cannotrotate about the abutment or implant because it is mated with thespecial contours on the exposed end of the abutment. The abutment issimilarly mated to the proximal or outer end of the implant. The crowncannot pull away from the abutment when the screw has been tightenedinto place.

Finally, the chimney above the screw is filled with a composite materialthat hardens and is shaped as part of the crown to look lie a naturaltooth.

There are many variations in construction.

In an alternative method, the crown is attached directly to a non-roundprotrusion of the implant and is held directly to the implant by a goldscrew without use of an intermediate abutment.

The implant is intended to be a permanent fixture in the jaw bone. Theabutment and crown may be replaced if necessary due to damage or poorfit by gaining access to the screw head by way of the chimney, andbacking off the screw so that the crown and abutment or crown to theimplant can be separated from the implant. Thus repairs may be made ofan abutment and crown with no or little inconvenience.

Therefore, the fit of an implant with the crown or frame must beperfect. If a prosthesis is placed into the mouth and does not seatcorrectly, the implant or abutment can be damaged. If an implant isdamaged there are not many options for its repair. In cases where therehave been a poor fit, the screws have broken inside the abutmentrequiring the replacement of the abutment. There have been cases wherethe screw broke inside the implant. The implants cannot be replacedwithout surgically removing them. Placing a new implant in the same spotis not an advised option.

Among related patents disclosing dental analogs include U.S. Pat. No.6,142,782 of Lazarof, which shows a dental analog with annular wings.However, the annular wings do not hinder rotating and thereforemisplacement of the analog within the replica cast stone. The annularwings of Lazarof do not intersect with the cast stone material enough toprevent rotation.

An alternative method for making dental prostheses that does not involvemaking an impression of the patient's mouth has been recentlyintroduced. It is based on Solid Freeform Fabrication (SFF) which is anindustrial prototyping technique whereby 3-D Computer Aided Design (CAD)files describing a part are used to guide the actual fabrication of asolid object by one of a variety of additive methods such asstereolithography, laminated object manufacturing, or fused depositionmodeling. U.S. Pat. No. 6,978,188 of Christensen as well as hispublished patent application 2005/0133955 illustrate how CT scans or MRIscans can be substituted for CAD input to create the files necessary todrive a stereolithography system which can then be used to model humanbone features. Medical Modeling LLC has used such a method in theirAccuDental™ system to create dental prostheses. Prior to implantation ofposts, a scan is made of a patient's jaw. This data is used to createfiles resulting in an accurate solid translucent resin model of apatient's jaw. Teeth and roots are rendered in a different hue to showclearly how the teeth are anchored in the jaw bone. A dental surgeonthen indicates on the jaw model where analogs are to be placed in themodel and at what angle they should be inserted. Holes are then drilledinto the jaw model to accept the analogs. A surgical guide is thermallyformed on top of the implant region of the model engaging the teeth orridge surface with a close fit and transferring the analog positionsaccurately. Alternatively, computer generated surgical guides which fitonto a jaw model are used. Surgical guide sleeves at the appropriateangle are then bonded at the analog sites onto the surgical guide. Thesurgical guide is snapped off the teeth or ridge surface of the modeland will be transferred to the patient's mouth and snapped onto theactual teeth or the ridge surface thereby providing accurate guides fordrilling the holes for the actual implants while at a remote lab, theprosthesis is being fabricated using the analogs in the jaw model.Surgical guides fit not only on teeth, but can be used on totallyedentulous jaws as well engaging soft tissue or bone surface asrepresented on the jaw model and on the actual patient jaw.

OBJECTS OF THE INVENTION

Accordingly, it is the object of the invention to provide a method forinsuring the most accurate seating possible of a prosthesis to anabutment or implant in the body of a patient.

SUMMARY OF THE INVENTION

The present invention comprises an implant analog that may include astandard abutment that can be mounted in the dental lab replica of therelevant section of a patient's mouth more securely than heretoforepossible. Because of the inventive implant analog, dental labs can nowcreate a crown that will attach more accurately to the implant in thepatient's mouth. The analogs of the present invention are desirablylonger than the analogs used heretofore and have a pin that projectsfrom the base of the analog. Desirably, the inventive analogs have aside ridge. Moreover, the analog has substantially the same height anddimensions as a conventional implant and abutment. In a preferredembodiment, the analog of the present invention is formed from stainlesssteel.

A careful confidential experiment was conducted at New York Universityof School of Dental Medicine by Dr. C. Jager, Dr. G. R. Goldstein, Dr.E. Hittelman and the Applicant herein. The experiment was designed tocompare the performance of a prior art analog of NOBEL BIOCARE®, asshown in FIG. 9, to that of one embodiment of the present invention, asshown in FIG. 4. A statistically significant improvement for the presentinvention was found in terms of framework fit. Also, resistance toapplied torque was found to be significantly improved for the analog ofthis invention.

The experiment evaluated torque prostheses to laboratory dental implantanalogs. The study evaluated the movement of the prior art analog ofNOBEL BIOCARE®, as shown in FIG. 9, and the embodiment shown in FIG. 4of the present invention. Both were torqued to 20 Ncm in a reinforcedtype IV die stone. 80 analogs were divided into groups of 4 analogs,including three of the prior art analog shown in FIG. 9 with one of thepresent invention shown in FIG. 4. These analogs were embedded in thirtyequal blocks of Type IV plaster stone using a prefabricated four unitimplant framework. Of the twenty analogs, ten were imbedded in the stoneat a depth of four cm and ten were imbedded at a depth of six cm fromthe implant platform. These groups of ten were then divided into groupsof five each, where five of the prior art analogs shown of the presentinvention in FIG. 9 were torqued to 20 Ncm in each group and fiveanalogs shown in FIG. 4 were torqued to 20 Ncm. The initial frameworkwas used to evaluate the fit of each analog therein. In the 4 mm depthgroup of the prior art shown in FIG. 9, two of the five samples (40%)did not allow the framework to fit the analog. In the 6 mm depth of theprior art analogs shown in FIG. 9, three of the five samples (60%) didnot allow the framework to fit. However, all of the dental analogs shownin FIG. 4 of the present invention fit back to the cast.

As a result, the analogs of the present invention, as shown in FIG. 4,were able to resist movement within a stone cast when torqued, unlike asignificant portion of the prior art dental analogs shown in FIG. 9.

Therefore, the dental analogs of the present invention have unexpected,beneficial results not achievable with the dental analogs of the priorart shown in FIG. 9.

A method of preparing dental crowns efficiently and accurately, includesthe steps of:

a. preparing an analog for a jaw implant supporting a dental crownmounting pin having at least one anti-rotation anchoring projectionextending discretely and radially from said pin adjacent a bottom endthereof;

b. inserting bottom-end-down said prepared mounting pin into a dentalcrown casting mold;

c. securing said prepared mounting pin temporarily in place within saidcasting mold;

d. adding settable plaster or plastic molding material to said castingmold so as to embed said bottom end of said pin by surrounding saidbottom end of said pin with said plaster or plastic molding material;

e. allowing said plastic molding material to set and harden with saidprepared pin embedded within said molding material; and

f. utilizing said embedded mounting pin to make a dental crown.

Regarding the alternative method described in the previous section usinga resin model of a patient's jaw, the analogs used must be resistant topull-out and rotation as in the method using the stone plaster method.Whether the resin model is a product of stereolithography or otherwisefabricated, it is drilled to accept an analog post. The alternateembodiment of this invention describes analog posts with features forrobustly grasping the side walls of these retaining holes in the resinmodel. Clearly, transverse or radially protruding features cannot beappended to the analog posts since these would not be compatible withinsertion.

The first alternate embodiment uses a single axially attached rod orwing on the lower portion of the analog post. The post is then forcedinto a slightly undersized hole and resists both twisting and pull-out.A second embodiment using axial rod features uses two such rods onopposite sides of the analog post. A third such embodiment uses threesuch rods attached every 120 degrees around the bottom end of the post.Any number of such rods can be attached preferably in a symmetric array.The rods can also be enhanced in their gripping action by texturizingtheir outer surface; alternatively, axial grooves along their length attheir outermost position can be added.

Another embodiment of analog post for hole engagement is made of alarger diameter with a tapered top; a regular array of longitudinalgrooves or flutes on the outer side surface engage the hole sides. Yetanother embodiment of analog post is one with a knurled outer surfaceand an annular groove near the bottom end. A final embodiment has malethreads along the analog shank which permit screwing into the hole inthe resin model much akin to the thread-forming action of a wood screwin a pilot hole in wood.

When using model based presurgical planning techniques, computer basedstereolithography or non-computer methods are used to create an accuratejaw model of resin, plaster, or “stone” or other plastic material.Similarly, surgical guides which form fit onto the jaw model and ontothe patient's jaw are also created. Once analogs are inserted into thejaw model, surgical guide sleeves are bonded to the surgical guide atthe analog sites using cement or adhesive inside oversized holes in thesurgical guide. These must be at the appropriate height, and theorientation must match that of the analogs in the jaw model. Anotherembodiment of this invention is a set of accessory parts and a method toinsure that the alignment of the surgical guide sleeves bonded to thesurgical guide will match that of the analog in registration.

After the analogs are inserted in the jaw model, at each analog siteattachments to each analog are made which will orient the surgical guidesleeve rigidly and accurately to represent the orientation of theanalog. After all the surgical guide sleeves are thereby attached to theanalogs, the surgical guide with oversize holes at each analog site islowered onto the jaw model and all surgical guide sleeves are bonded tothe surgical guide while they are still attached to the analogs. Afterthe cement or adhesive sets, screws are removed from each analog to freethe surgical guide with all of the surgical guide sleeves accuratelyattached. The guide is then used inside the patient's mouth to drillaccurate implant holes by using each of the surgical guide sleeves asdrill guides.

The parts attached to each analog in the jaw model are a surgical guidesleeve supported by a form-fitting cylinder support mount, a tubeadapter to adjust the height of the guide sleeve above the analog (ifnecessary), and a screw threaded through the three parts from the top tosecure the assembly to the analog below.

Presurgical planning techniques using accurate whole skull models ormodels of skull portions other than jaws are also used for cranial andfacial reconstruction. Attachments use surgical implants in bone. Forexample such an approach is used to repair missing bone in the cranium,ear prostheses, and nose prostheses. The procedure starts with anaccurate model and a surgical guide with oversize holes in registrationwith the analogs inserted at sites determined by a surgeon on the skullmodel. Using the procedure and analog attachments as described above fordental implants, appropriately sized tube adapters, cylinder supportmount, surgical guide sleeve and attachment screw are attached to eachanalog in the skull model. The surgical guide is then fitted carefullyatop the protruding elements atop each analog, and the surgical guidesleeves are cemented or otherwise bonded within the oversize holes ofthe guide capturing the precise angle of the analog in the model. Theanalog screws are then removed releasing the surgical guide with guidesleeves attached for accurate drilling during the surgical procedure forinsertion of the implants.

Another example involves the use of bone harvested from the patient,which is implanted to repair bone damaged by trauma or surgery in adifferent part of the body. In some cases, bone harvested from a cadaveris used instead.

In this particular example, bone harvested from the iliac crest of thesame patient is used to repair or reconstruct the patient's jaw. Modelsmade by any of the Solid Freeform Fabrication (SFF), i.e. 3D printingprocesses, are made from CT and/or MRI scans of both the iliac and thejaw. These models will be used to plan the two surgeries and to createsurgical guides for precise parts fit and joining by pins and bonding orby the use of surgical screws.

Other examples of the use of SFF models and accurate analogs forpre-surgical planning are far removed from the vicinity of the skull. Inone example, a removable prosthesis for the distal phalanx is fitted tothe middle phalanx bone. In a further example, a fibula fracture isrepaired with a plate accurately screwed into the fibula by using asurgical guide to drill the holes for the bone screws.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention can best be understood in connection with theaccompanying drawings. It is noted that the invention is not limited tothe precise embodiments shown in drawings, in which:

FIG. 1 is a view of a dental lab replica showing the position of ananalog and an abutment;

FIG. 2 is a view of a lower jaw about to receive a prosthesis and havingtwo implants;

FIG. 3 is a view of an embodiment of the present invention incorporatinga conical abutment;

FIG. 3A is a partial view taken within the phantom circle of FIG. 3,shown rotated ninety degrees for clarity;

FIG. 4 is a view of an embodiment of the present invention incorporatinga standard abutment;

FIG. 5 is a view of an embodiment of the present invention correspondingto an implant with a hexagonal protrusion;

FIG. 6 is a view of an embodiment of the present invention correspondingto a large diameter implant with a hexagonal recess;

FIG. 7 is a side elevation view in partial cross section of anembodiment of the present invention corresponding to an implant with ahexagonal recess;

FIG. 7A is a top plan view thereof;

FIG. 8 shows a conventional impression coping with depth indicationsfrom 2-5 mm;

FIG. 9 shows a conventional prior art fixture replica, or analog, whichis replaced by analog according to the present invention;

FIG. 10 shows the placement of a fixture replica, either a conventionalor according to the present invention, in the lab replica that is to besecured to an abutment and a crown via a guide pin;

FIG. 11 shows the attachment of a fixture replica, either a conventionalor according to the present invention, to an impression coping that isfixed in an impression of the relevant section of a patient's mouthprior to the casting of the lab replica;

FIG. 12 shows a dental impression tray modified to provide access to theimpression coping that is secured to the implant in a patient's mouth bya guide pin;

FIG. 13 shows the excess material around the impression coping in a traycontaining impression material, the impression coping being secured tothe implant in the patient's mouth by a guide pin;

FIG. 14 shows a means of securing the impression coping to the traycontaining the impression material with an acrylic resin;

FIG. 15 shows the impression containing the impression coping;

FIG. 16 is a top view of an engagement plate of this invention which isused to provide improved anchorage for a conventional analog;

FIG. 17 is an exploded side view of the engagement plate of FIG. 16attached to a conventional analog;

FIG. 18 is a perspective view of an analog body with a transverse tubeconfigured to screw into a variety of abutments;

FIG. 19 is a perspective view of an analog body with transverse wings;

FIG. 20 is a bottom view of an analog body with transverse wings;

FIG. 21 is a perspective view of an analog body with coplanar transversetubes at right angles;

FIG. 22 is a perspective view of an analog body with non-coplanaroblique tubes;

FIG. 23 is a bottom view of an analog body with eight co-planartransverse tube segments;

FIG. 24 is a perspective view of an analog body with angled spikes;

FIG. 25 is a side elevation of an analog body with serrated sideextensions;

FIG. 26 is a side elevation of an analog body with four serrated andperforated side extensions;

FIG. 27 is a perspective view of an analog body with looped sideextensions;

FIG. 28 depicts a cross-sectional view of a protrusion in an analoghaving a substantially oval shape 2802;

FIG. 29 depicts a cross-sectional view of a protrusion in an analoghaving a substantially triangular shape;

FIG. 30 depicts a cross-sectional view of a protrusion in an analoghaving a substantially square shape;

FIG. 31 depicts a cross-sectional view of a protrusion in an analoghaving a substantially rectangular shape; and,

FIG. 32 depicts a cross-sectional view of a protrusion in an analoghaving a substantially hexagonal shape 3202.

FIG. 33 is a (prior art) perspective view of a plastic resin jaw modeland a surgical guide illustrating the relation between the two.

FIG. 34 is a (prior art) perspective view of a resin jaw model withanalog posts installed.

FIG. 35 is a perspective view of an analog post of this invention with asingle side rod or wing attached.

FIG. 36 is a perspective view of an analog post with two axial wings.

FIG. 37 is a top plan view of an analog post with three symmetricallyattached side rods or wings.

FIG. 38 is a side elevation detail showing texturing on the side of arod or wing.

FIG. 39 is a perspective detail of showing a longitudinal groove on theside of a rod.

FIG. 40 is a perspective view of a fluted analog post.

FIG. 41 is a perspective view of a knurled analog post with an annulargroove adjacent the bottom end.

FIG. 42 is a side elevation of an analog post with male thread on itsshank surface.

FIG. 43 is a perspective view of a cylinder sleeve support mount.

FIG. 44 is a side crossection of the mount of FIG. 43.

FIG. 45 is a side crossection of the cylinder sleeve support mountinside a surgical guide sleeve to show the fit of the two parts.

FIG. 46 is a side elevation of a retaining shoulder screw.

FIG. 47 is a perspective view of a short tube adapter.

FIG. 48 is a perspective view of a medium height tube adapter.

FIG. 49 is a perspective view of a larger diameter and taller tubeadapter.

FIG. 50 is a side exploded view of the five parts from top screw tobottom analog.

FIG. 51 is a side detail crossection of two assemblies attached to twoanalogs in a jaw model with a section of surgical guide in registrationwith the two analogs but spaced apart for clarity.

FIG. 52 is a perspective view of an accurate skull model showing analogsinserted for cranial repair, ear prosthesis, and nose prosthesis withaccurate surgical guide for the cranial repair.

FIG. 52A is a perspective view of a skull model as in FIG. 52, showingsurgical guides and actual prostheses for an ear, eye, and nose.

FIG. 52B is an exploded perspective view of an ear prosthesis beingattached by attachments to a frame permanently attached in situ to ahuman patient, where the locations of fasteners to the skull areaccurately determined by analogs used to locate holes in a skull modelconstructed of resin or other modeling medium by use of 3-dimensionalmodeling, such as stereolithographic modeling. Preferably, the analogsused in the resin model, have anti-rotational elements, such as, forexample, disclosed in FIGS. 2-8,10-32 and 35-51 herein.

FIGS. 52C, 52D, 52E, and 52F are detail views of an eye prosthesis beingattached to a frame permanently attached in situ to a human patient,where the locations of fasteners to the skull are accurately determinedby analogs used to locate holes in a skull model constructed of resin orother modeling medium by use of 3-dimensional modeling, such asstereolithographic modeling.

FIGS. 52G, 52H and 52I are front detail views of a nose prosthesisattached to a frame attached to anchors embedded in the skull of a humanpatient, where the locations of fasteners to the skull are accuratelydetermined by analogs used to locate holes in a skull model constructedof resin or other modeling medium by use of 3-dimensional modeling, suchas stereolithographic modeling.

FIG. 53 is a perspective view of an accurate mandible model with an areadamaged by accident trauma or by loss of bone due to disease orinfection.

FIG. 54 is a perspective view of the model of FIG. 52 aftersegmentectomy of the lower jawbone in preparation for a bone graftrepair.

FIG. 55 is a top plan view of part of the iliac model showing a cuttingguide temporarily attached to the crest of the illium.

FIG. 56 is a perspective view of the mandible model with a model of thebone graft fitted in place and screwed into the mandible model viascrews in a repair plate.

FIG. 57 is a perspective view of a repair piece fitted into the recessleft by the bone harvested from the crest of the illium which willrestore the integrity of the superior pelvic brim for cosmetic purposes.

FIG. 58 is a perspective view of the completed distal phalanx prosthesisbeing fitted onto a frame attached at the end of the middle phalanxbone.

FIG. 59 is a perspective view of the end of an accurate model of themiddle phalanx bone with an analog installed to accurately position andbond a sleeve into a surgical guide.

FIG. 60 is a perspective view of the completed distal phalanx prosthesisshowing attachment clips with mating frame on the finger end.

FIG. 61 is a perspective view of an accurate femur and fibula model usedto repair a fibula fracture with the aid of a surgical guide toaccurately drill holes for attachment bone screws.

FIGS. 61A and 61B are perspective views of accurate hip models used torepair arthritic hips with hip replacement prostheses, to accuratelydrill holes for attachment supports.

FIG. 62 is an exploded perspective view of an accurate femur and fibulamodel showing a cutting guide to be attached to a region in dashed linesin a fibula in preparation of a shallow bone graft repair of a jaw withteeth implants, as in FIG. 63.

FIG. 63 is a perspective view of a mandible model after segmentectomy ofthe lower jawbone in preparation for a bone graft repair showing a bonegraft with analogs for teeth implants in place in the stereolithographicresin model.

DETAILED DESCRIPTION OF THE INVENTION

Simplified, the construction of the prosthesis begins after theosseointegration of the implant with the dentist making an impression ofthe relevant section of the patient's mouth. When constructing theprosthesis, the dentist makes an impression including an impressioncoping. Desirably, the impression material employed is hard and elasticwhen set, such as the materials sold under the trade names IMPRAGUM,EXPRESS and PRESIDENT.

Once the impression material hardens, the tray containing the impressionis sent to a dental lab where the prosthesis is made. The dental labuses this impression to make a replica of the relevant section of thepatient's mouth. Typically, the replica is made of gypsum to formplaster, and is made to reproduce the milieu into which the prosthesisis to fit, including, for example, any hexagonal protrusion or recessionin the abutment the dentist is using. Alternately, the replica can alsobe made of plastic, such as resin.

For example, FIG. 1 shows a view of dental lab replica 130 with analog120 and abutment 110.

Moreover, FIG. 2 shows an actual patient lower jaw with two implants220, a three tooth prosthesis 210 and screws 230 to retain prosthesis210 in implants 220.

In making the impression, the impression coping is attached to theimplant in the same way the final prosthesis will attach. The impressioncoping rests flush on top of the implant, or implant and abutment, witha guide screw passing through and into the implant. The impressioncoping remains in the impression in the same position that was in themouth and the guide screw must be removed before the impression can beremoved from the patient's mouth.

In making the dental lab jaw model, or replica, the analog is attachedto the impression coping with a guide screw going through the impressioncoping and into the analog. All of the teeth in the relevant portion ofthe mouth are replicated in the model, which desirably is made ofgypsum. The goal is to have the analog in the replica in the positionthat corresponds to the position of the implant in the patient's mouth,including the orientation of any protrusion or recess.

The present day tools offered by the implant manufacturers utilize brassor stainless steel analog.

The configuration of the prior art analogs replicates the internalthread dimension of the implant or abutment and copies the shape of theexternal or internal hexagon. However, the outside diameter of a priorart analog maintains a shape that is not consistent with the needs ofthe dentist or technician in constructing the prosthesis. Conventionalanalogs are too small and are removed from the gypsum model too easily.Moreover, the exterior surface of conventional analogs are too smoothwhich permits the analog, and thus the prosthesis, to rotate in themodel during construction of the prosthesis. Such rotation moves thehexagonal position of the prosthesis into a position that does not matchthe corresponding position of the implant in the patient's mouth.

In contrast to the prior art conventional, easily rotatable anddislodgable dental analogs, the present invention is a new analog thatwill not allow any rotation in the gypsum model. In a preferredembodiment, as shown in FIGS. 3 and 3A, the analog 320 of the presentinvention is substantially longer and has a unique feature of atransverse pin 312 or other protruding geometric shaped member extendingthrough hole 314 in its side.

FIG. 4 shows analog 420 with abutment 22 and hole 414 for insertion of apin therein, similar to pin 312 of FIG. 3A.

As shown in FIGS. 5, 6, and 7, these dental analogs 520, 620 and 720 ofthe present invention are preferably ridged with annular recesses, thesedental analogs 520, 620 and 720 on their respective sides to gain betterretention inside the gypsum model.

Analogs 420, 520, 620 and 720 have respective pins (not shown) similarto transverse pin 312 of analog 320 of FIG. 3A. These pins 312 arelocated at the base of the respective analogs 320,420, 520, 620 and 720to lock the position. These transverse pins 312 prevent horizontal,vertical or cylindrical movement of the analogs 320, 420, 520, 620, and720 within the model.

Conventional implants have a standardized system of heights,measurements and dimension for implants and abutments. The respectiveinventive analogs 320, 420, 520, 620, 720 of the present invention canhave a shape which incorporates a conical abutment 322 (FIGS. 3 and 3A),a standard abutment 422 (FIG. 4), a hexagonal protrusion 522 (FIG. 5), alarge hexagonal recess 622 (FIG. 6) or a hexagonal recess 722 (FIG. 7),as these terms are used in the dental industry. For example, FIGS. 28-32depict cross-sectional views of protrusion embodiments having variousshapes. Illustratively, FIGS. 28-32 are described with respect toprotrusion 2012 however that description is not intended in any way tolimit the scope of the invention. For example, it is appreciated thatextensions 2051 may in various other embodiments have the shapesdepicted in FIGS. 28-32. FIG. 28 depicts a cross-sectional view ofprotrusion 2012 having a substantially oval shape 2802. FIG. 29 depictsa cross-sectional view of protrusion 2012 having a substantiallytriangular shape 2902. FIG. 30 depicts a cross-sectional view ofprotrusion 2012 having a substantially square shape 3002. FIG. 31depicts a cross-sectional view of protrusion 2012 having a substantiallyrectangular shape 3102. FIG. 32 depicts a cross-sectional view ofprotrusion 2012 having a substantially hexagonal shape 3202.

Analogs 520, 620 and 720 also bear annular grooves 516, 616 and 716.

The analogs 320, 420, 520, 620 and 720 of the present invention aremachined to specified mechanical tolerances. In particular, the internalthread of the inventive analogs are closer to the threads of actualimplants and abutment. This closer approximation to the actual implantsinsures that the guide screw goes into the implant the same number ofturns the guide screw goes into the analog, and maintains the prosthesisin the same position relative to the patient's mouth as the prosthesishad with respect to the replica. The internal or external hexagon isalso closer in dimensions to the actual implant. As a result, theprosthesis will fit on the analog and on the actual implant or abutmentin the manner intended.

Another complication in the construction of dental analogs is that it isoften necessary to construct a large frame using soldered connections.The present methods of soldering require a duplicate model of high heattolerance gypsum investment be made with the present day analogs. Theframe is soldered on that model. The success rate of these solderconnections is far lower than expected in the industry. The presentinvention allows a more accurate solder connection. The presentinvention also holds better in the invested model and keeps the analogsfrom moving in the model.

EXAMPLE

In the single tooth prosthetic work, the impression is taken from thefixture level. As shown in FIG. 8, one type of conventional impressioncoping 800 has an internal hexagon at the base, which corresponds to thehexagon of the abutment. The coping has depth indications for assessmentof proper abutment size, 2 mm, 3 mm, 4 mm, and 5 mm. The upper margin ofthe abutment-like part indicates 6 mm. The impression coping istypically made of titanium.

The impression coping is used together with a special guide pin (e.g., aDCA 098), 850, for a single tooth (the guide pin used to secure theprosthesis to the implant typically has a different thread).

Typically, in the laboratory, any undercuts of the impression coping areblocked out before pouring the impression (including the depthindications). This blocking is especially important when the longestabutment is used. This precaution prevents fracturing the cast whenseparating the model and the impression coping.

During the Laboratory procedure, an analog, for example a conventionalprior art analog 900 shown in FIG. 9, or an analog of the presentinvention such as the analogs of FIGS. 3-7, is used in the laboratoryjaw model, or replica, to represent the implant in the working cast.This is illustrated in FIG. 10 where analog 1000 is set in thelaboratory jaw model, or replica, 1010, and the abutment 1020 and crown1030 are secured to the jaw model by guide pin 1040. The analog has thesame top hexagon and internal thread as the implant. In contrast to thestainless steel analogs of the present invention, conventionally,analogs were typically made of nickel-plated brass.

FIG. 11 shows an impression 1100 containing an impression coping 800being attached to an analog 1000 via guide pin 1040. Once the analog1000 is secured to the impression coping 800 by the guide pin 1040, theimpression 1100 is used to cast he laboratory jaw model, or replica,from stone, such as gypsum.

The impression 1100 containing the impression coping 800 can be preparedin any conventional manner. For example, as shown in FIG. 12, one canmake a hole 1200 in an acrylic-resin stock tray 1210 for access to theimpression coping 800 which is secured to the implant by the guidescrew.

FIG. 13 shows tray 1210 loaded with an impression material of choice1300 in the mouth with impression coping 800 secured to implant 120within the patient's jaw 1310.

FIG. 13 also shows the removal of any excess material around impressioncoping 800 once impression material 1300 has set.

Impression coping 800 is then secured to tray 1210 withauto-polymerizing acrylic resin 1400. The orientation of the hexagonalhead of the implant 120 should be maintained when the impression 1100 isremoved. Next, guide pin 850 is unscrewed and impression 1100 iscarefully removed form the patient's mouth.

As noted before, FIGS. 3-7 show different embodiments of the dentalanalogs 320, 420, 520, 620 and 720 of the present invention each using atransverse rod pin 312 or tube within hole 314, 414, 514, 614, or 714,in the base section of each analog 320, 420, 520, 620, or 720 to enhancethe anchoring of the analog in the plaster of the replica. Each of thedifferent embodiments uses a different style of abutment 322, 422, 522,622, or 722 to match that which the dentist had used in the patient'sactual implant.

For example, FIG. 3 shows a conical abutment 322 for analog rod 320 andFIG. 4 shows a standard recessed abutment 422 for analog rod 420. FIG. 5shows an abutment 522 with a hexagonal protrusion for analog rod 520,FIG. 6 shows a large diameter abutment 622 with a hexagonal recess, foranalog rod 620, and FIG. 7 shows an abutment 722 with a hexagonal recessfor analog rod 720.

FIG. 16 shows another embodiment of this invention in the form of a flatengagement plate 2000 which is used to provide enhanced anchoring of astandard prior art analog 900 (see FIG. 9) in the replica plaster.

As shown in FIG. 17, the conventional analog 2003 is inserted throughcentral hole 2001 and adhesively bonded 2004 at an oblique angle.Perforations 2002 enhance adhesion to immobilize plate 2000 in replicaplaster. An optional hollow sleeve 2005 can be used to extend thevertical height of analog 2003, to further promote its anchoring withinthe replica plaster.

It is further noted that optional removable hollow sleeve 2005 can alsohave any of the protrusions shown in the other drawing figures, such asprotrusion rods 2012 of FIG. 18 or FIG. 21, protrusion 2022 of FIG. 19,protrusion wings 2030 of FIG. 23, protrusion barbs 2032, protrusionwings 2035 of FIG. 25, protrusion wings 2040 of FIG. 26 or protrudingloops 2051 of FIG. 27.

FIG. 18 shows the concept for a series of additional embodiments ofanalogs of this invention which use a tubular body 2010 with externalthreads 2011 at the top end. These threads screw into mating femalethreads on a series of abutments 2013 (here illustrated as a conicalabutment) which are supplied to match the style and size actuallyimplanted in the patient's jaw.

Therefore, analogs of this general category of embodiments can bematched with a variety of abutments 322, 422, 522, 622, or 722 (asdescribed in FIGS. 3-7). The analog 2010 with conical abutment 2013 ofFIG. 18, similar to analog 320 with a conical abutment 322, uses atransverse tube or rod 2012 to aid in anchoring body 2010 in plaster.Slotted body 2020 as shown in FIG. 19 accepts two rectangular wings 2021(as shown in bottom view of FIG. 20) with perforations 2022 as yetanother embodiment to resist rotation within, and extraction from, thereplica plaster.

The embodiment shown in FIG. 21 uses coplanar radial transverse tubes2012 at right angles to each other to provide anchorage.

The embodiment shown in FIG. 22 uses two oblique tubes 2012 whichpenetrate body 2010 as anchorage.

The bottom view of the embodiment of FIG. 23 shows eight equally spacedtubular segments 2030 attached to body 2010 to provide anchorage inreplica plaster.

FIG. 24 shows an embodiment of an analog using tubular body 2031 withupward angled spikes 2032 in two rows to provide anchorage.

The embodiment of FIG. 25 shows slotted body 2020 with a pair ofserrated triangular wings 2035 to provide anchorage in the replicaplaster.

FIG. 26 shows an embodiment of an analog with body 2039 with four slotsaccommodating four perforated and serrated triangular wings 2040 torigidly anchor it to the plaster of a replica.

Furthermore, FIG. 27 shows an embodiment of an analog using tubular body2050 with one or more outwardly extending looped extensions 2051 topromote anchorage.

FIG. 33 illustrates some features of the alternate method incorporatinga resin jaw model to fabricate a prosthesis. Resin jaw model 4000 istranslucent and shows teeth in a contrasting hue in the jaw. Marks 4001placed by a dental surgeon indicate the location for the center of eachanalog hole to be drilled. Marks 4002 illustrate the proper angle forsuch analog retaining holes. Surgical guide 4010 is shown “popped-off”the teeth of jaw model 4000 over which it is formed by a thermalprocess. Surgical guide sleeves 4011 are shown attached at the properangles to drill the implant post holes in the patient's jaw. Threeanalog posts 4020 are shown installed in jaw model 4000 in FIG. 34.

The analog posts in FIGS. 35-42 all have features to resist pull-out androtation when installed in holes of a resin jaw model. FIG. 35 showsanalog post 4030 with one side rod or wing 4032. FIG. 36 shows analogpost 4035 with two wings 4032 attached to opposite sides of post shank4031. FIG. 37 shows a symmetric attachment of three side wings 4032 froma top view. In all cases, these analog posts are forced inside a holeslightly smaller than would normally accommodate an analog shank withits side wings. The wings will embed into the sides of the retainingholes. FIG. 38 shows texturing 4046 as applied to outer edge of sidewing 4032 to aid in retention. FIG. 39 shows groove 4051 along thelength of side wing 4032 which can be used for the same purposealternatively.

In lieu of side wings or attached rods, FIG. 40 shows fluted analog post4055 with longitudinal grooves 4057 and a tapered top end 4056 whichwould be below the top surface of the retaining hole. FIG. 41illustrates yet another embodiment of analog post 4060 which is knurled4061 along its entire outer shank. An annular groove 4062 also enhancespull-out resistance. The analog post 4065 of FIG. 42 is screwed into ananalog hole via tapered bottom 4066 and thread-forming male threads 4067along its shank.

FIGS. 43-51 illustrate a presurgical method for aligning surgical guidesleeves in a surgical guide so they can be bonded in the properorientation for use in a patient's mouth to accurately drill holes foraccepting implant posts. Three parts are used for this. FIG. 43 shows acylinder sleeve support mount 4080 with center hole 4083, shank 4082 andflange 4081. FIG. 44 shows the key dimensions of the various parts whileFIG. 45 shows the fit of support mount 4080 within surgical guide sleeve4011. The O.D. of flange 4081 (DD) matches the O.D. of guide sleeve4011. Shank 4082 of diameter D fits in a close clearance fit insideguide sleeve 4011 which is slightly longer (LL) than height dimension L.This is to insure rigid locking by shoulder screw 4090 of FIG. 46 whichhas a head 4091 also of dimension DD; threads 4093 engage the centralthreaded hole of an analog. Note that shoulder 4092 diameter d1 isslightly smaller (close clearance fit) than hole of diameter d insupport mount 4080. FIGS. 47-49 illustrate three different heights h1,h2, and h3 of tube adapters 4100, 4110, and 4120 respectively whichmatch the outside diameter (O.D.) of an analog. Analog 4120 would beused with a larger diameter analog. Many such adapters would be madeavailable to adjust the height of the surgical guide sleeve above thetop of an analog as required. FIG. 50 shows an exploded view of theassembly of the five parts. Although analog 4065 of the screw-in varietyis shown, any analog would usable with this method. Referring to FIG.51, side crossection detail 4150 of the jaw model shows two analogs, one4065 screw type and one knurled type 4060, rigidly installed. The methodrequires that the progression of parts as shown in FIG. 50 is assembledand accurately and rigidly held in place by tightening screw 4090 ineach analog beneath. Note that analog 4065 has short tube adapter 4100atop while analog 4060 uses a taller 4110 adapter. In FIG. 51, theflange portion of each cylinder sleeve support mount 4080 is visibleatop the tube adapter while surgical sleeve guide 4011 is captured andguided between the head 4091of screw 4090 and flange 4081 of mounts4080. Note also that analogs 4065 and 4060 are tilted away from eachother (not aligned) as required by the desired positioning in the jawmodel. A section of surgical guide 4160 is shown above jaw model 4150with oversize holes 4161 in registration with analogs 4065 and 4060.After the surgical guide 4160 is carefully aligned with jaw model 4150,surgical sleeve guides 4011 will be within holes 4161 where they will bebonded to surgical guide 4160. After the adhesive or cement cures,screws 4090 will be removed thereby releasing surgical guide 4160 fromjaw model 4150 with surgical sleeve guides accurately attached. Analogs4065 and 4060 will then be used by the dental lab for fabrication ofappropriate prostheses. When the prostheses are made (or before),surgical guide 4160 is returned to the dental surgeon. It is used toaccurately drill implant post holes in the patient's jaw using thesurgical sleeve guides as drill guides to replicate the orientation ofthe analogs in the jaw model for a close fit of the prostheses.

FIG. 52 shows a skull model 4200 which is typically created usingstereolithography. Analog group 4215 (8 analogs) placed around cranialinjury area 4210 will be used to plan the surgery. Also shown are agroup of five analogs 4240 which will be used to attach an earprosthesis, and a pair of analogs 4260 for a nose prosthesis. All threesites will also require accurate surgical guides for these procedures.One of these, 4220 for the cranial repair, is shown in the figure. Notethe oversize holes 4215 in registration with the array of analogs 4215.Two exemplary surgical guide sleeves 4227 are shown indicating that atotal of 8 such sleeves will have to be accurately bonded inside holes4225. To facilitate this step, the parts shown in FIG. 50, namely tubeadapter 4100, support mount 4080, surgical guide sleeve 4011 (4227 inFIG. 52), and screw 4090, are assembled in the order shown atop eachanalog 4215. Then surgical guide 4220 is placed accurately over therepair area 4210 with guide sleeves 4227 inside holes 4225. Sleeves 4227are then bonded to guide 4220. All screws 4090 are then removed therebyreleasing surgical guide 4220 with accurately bonded guide sleeves 4227;the guide sleeves will be used for drilling holes for the actualimplants in the surgical procedure. Surgical guides for the ear and noseprostheses (not shown) would be similarly prepared.

FIG. 52A shows a skull model 4200 with analogs installed (as in FIG. 52)for three other prostheses. Surgical guide sleeves 4227 are accuratelybonded into oversize holes in the surgical guides, which would be usedfor accurate screw guide holes in the patient's skull to attach framesfor the prostheses. Preferably, the analogs used in the resin model,have anti-rotational elements, such as, for example, disclosed in FIGS.2-8, 10-32 and 35-51 herein.

For example, FIG. 52B shows an ear prosthesis 5110 being attached by anattachment, such as by spring clips 5110 a attached to a bar or frame5110 b, permanently attached in situ to a human patient. In preparationfor such in situ attachment in the patient. Other applicable attachmentsinclude snap attachments, locator attachments, ball attachments, ERAattachments, Gilmore bar attachments, Hader attachments, etc. First, inthe three dimensional model, surgical guide 5100 for ear prosthesis 5110with two oversize holes is screwed into analog holes 4230 for accuratebonding of sleeves 4227. Thereafter, ear prosthesis 5110 therefore wouldattach via clips 5110 a or other removable fasteners, to the patient'sskull via a frame 5110 b (as shown in FIG. 52B) which is attached usingbone screws 5110 c using guide holes 5110 e accurately drilled by usingsurgical guide 5100 and at locations in the patient's skull analogous toanalog holes 4230 in skull model 4200 of FIG. 52A.

Similarly, as also shown in FIG. 52A, angled surgical guide 5120 isattached to analogs 4240 so that three guide sleeves 4227 can be bondedfor later use in providing an attachment frame accurately screwed intothe patient's skull to retain eye prosthesis 5130, as shown in FIGS.52C, 52D, 52E and 52F. FIG. 52C shows a region 5130′ for attachment witheye prosthesis 5130, which is attached, as shown in FIG. 52D to frame5230 a having fasteners 5130 c to the patient's skull at locations 5230e, which are analogous to analog holes 4240 in skull model 4200 of FIG.52A. FIG. 52E is a close-up view of eye prosthesis 5130 and FIG. 52Fshows eye prosthesis 5130 in place upon the skull of a patient's face.

As also shown in FIG. 52A, surgical guide 5140 for nose prosthesis 5150is attached to two analogs 4260 for accurate bonding of sleeves 4227.Guide 5140 is then used for accurate drilling of guide holes for bonescrews that will retain a frame (not shown) to patient's skull for noseprosthesis 5150, which is held in place at anchor locations 5150 e ofFIG. 52H, so that nose prosthesis 5150 is accurately placed upon theface and skull of a patient, as shown in FIG. 52I.

FIGS. 52C, 52D, 52E, and 52F are detail views of an eye prosthesis beingattached to a frame permanently attached in situ to a human patient

FIGS. 52G, 52H and 52I are front detail views of a nose prosthesisattached to a frame attached to anchors embedded in the skull of a humanpatient.

FIGS. 53 through 57 illustrate the repair and reconstruction of a bonearea, such as a mandible damaged by accident, a disease or infection,and using a bone graft harvested from the patient's own illium, fibulaor rib, etc. SFF models such as stereolithography and other types of 3Dadditive manufacturing techniques are used in this example.

FIG. 53 shows mandible model 5000 with extensive damage to region 5001,damaged tooth 5002, and damaged molar 5003. A patient scan is the basisfor this accurate model. The first step in pre-surgical planning is toextract the damaged teeth 5002 and 5003 in the model and then performinga segmentectomy of the lower jaw by cutting the damaged bone into arectangular recess.

This is shown in FIG. 54, where teeth have been removed at 5012 and5013, while a rectangular recess 5010 now is at the site of damaged area5001 (shown in FIG. 53). By measuring recess 5010 on jaw model 5000, aminimum size for a bone graft is obtained. The actual bone graftharvested must be larger in all dimensions than the damaged area 5001,to allow for fixturing during the shaping process of the damaged bone inthe jaw, which is performed using subtractive methods of the damagedarea 5001, such as milling, grinding, and possibly routing.

FIG. 55 shows illium model 5020 with a cutting guide 5025 temporarilybonded to crest 5021 of the bone graft donor area. The surgical guide5025 is dimensional using SLA modeling to exactly fit the recess 5010 inthe patient's jaw, to receive the surgical guide 5025. Note that guide5025 is dimensioned to obtain a bone graft 5030 that is larger thanrecess 5010 in all dimensions. Guide 5025 is shown with holes 5042 foraccurate placement of analogs 5032 in bone graft 5030, shown in FIG. 56

Once the model iliac bone graft is harvested, it is scanned, so that anaccurate model in a different biocompatible material can be later madepreferably by a 3D printing technique. The material can be a resin oreven a sintered metal. This is done before the model harvested bonegraft is shaped to fit jaw recess 5010.

FIG. 56 shows mandible model 5000 fitted with shaped model bone graft5030 which is screwed into place via plate 5031. In the actual jaw,plate 5031 is typically titanium. Using autogenous bone eliminates alarge number of possible tissue rejection problems. Also, with anautogenous bone graft in an actual jaw, osseointegration is promoted tobond the graft and mandible intimately. Analogs 5035 and 5036 are usedto locate replacements for damaged teeth 5002 and 5003 respectively. Forexample, one or more analogs 5032, such as three analogs 5032 shown inFIG. 56, are used to locate teeth that were completely destroyed bytrauma, disease or infection and must now be replaced in bone graft5030. Surgical guide 5040 with front alignment surface 5041 and oversizeholes 5042 will be used in the actual surgery to guide drilling of holesfor posts. First, however, it is screwed down onto the analogs of themodel so that guide sleeves 4011 can be accurately bonded within holes5042. Note that sleeves 4011 are part of assemblies including tighteningscrews 4090, mounts 4080, and adapters 4100 designated in FIG. 56 asitems 5045.

The actual surgery commences with the bone harvesting of bone graft 5030(using cutting guide 5025) from a bone graft donor site, such as theillium first, as shown in FIG. 55, with placement in the mandible 5000,as shown in FIG. 56.

Optionally, if the patient is concerned about a possible cosmetic defectresulting by the missing bone graft material at the illiac brim, a modelof the missing graft harvested can be refit as a replacement during theactual bone harvesting surgery. This must be ready for attachment at thetime of the surgery. FIG. 57 shows such a “filler” 5050 attached at theharvest site 5051 on iliac crest 5021 by bone screws 5052. Biocompatiblecement can be used as an alternative attachment or in conjunction withthe two small bone screws shown.

The harvested bone graft to be placed in the patient is then shaped withsurgical guide 5025 identically to the model bone graft 5030 in themodel, prior to the start of the mandible surgery. Then segmentectomy ason the model will then be surgically performed on the mandible. Actualbone graft is then attached using a titanium plate identical in size andshape to 5031. Then, at least one post hole using surgical guide 5042,such as one or more post holes, such as the five post holes, areaccurately drilled in the jaw bone or bone graft as required.

Another example of the techniques of this invention is the fitting of aprosthetic distal phalanx to the middle phalanx bone. This isillustrated in FIGS. 58-60.

FIG. 58 shows a completed prosthetic with removable prosthetic distalphalanx 5060 which is insertable via an attachment, such as, forexample, clip plate 5061 onto retention frame 5062, which is attached tomiddle phalanx bone 5065. Actual finger contour is shown at 5067 as wellas proximal phalanx bone 5066. Other applicable attachments include snapattachments, locator attachments, ball attachments, ERA attachments,Gilmore bar attachments, Hader attachments, etc.

FIG. 59 shows the end of middle phalanx bone model 5065 with analog 5070accurately inserted. Surgical guide 5071 with alignment rim 5072 andoversize hole 5073 is shown with guide sleeve assembly 5074 (as in 5045above). Guide sleeve assembly 5074 is screwed into analog 5070 to permitthe guide sleeve 4011 of the assembly, to be accurately bonded withinsurgical guide 5071. Then surgical guide 5071 is transferred to theactual bone 5065 end to drill a hole to retain frame 5062 via bone screw5063 as shown in FIG. 60. Prosthesis 5060 has spring plate 5061 withfour spring clips which engage frame 5062 cross pieces. Recess 5076cosmetically hides spring clips of plate 5061.

A further example shows how an SFF model of a femur and fibula with afracture is used with analogs and a surgical guide to repair thefracture using a plate. FIG. 61 shows the accurate model of the femur5080 and fibula 5081 obtained by 3D printing from a CT scan. Fracture5082 in the fibula is to be repaired using a metal plate screwed intoplace by accurate holes drilled using surgical guide 5085. In the modelview of FIG. 61, analogs 5088 are accurately inserted into model fibula5081. Surgical guide 5085 with oversized holes 5086 is screwed intoanalogs 5088 via surgical guide screw assemblies 5087, wherein surgicalsleeves 4011 (part of 5087 assemblies) are bonded within holes 5086.Then guide 5085 is removed from the model and transferred to accuratelydrill the bone screw holes during the surgery on the fibula.

As shown in FIGS. 61A and 61B, similar surgical guides and analogs canbe used for attaching a ball and socket for a hip or knee replacement,by more accurately locating the size and orientation of fixating members(such as rods or screws) in the receptor site.

While a large bone graft would need to be harvested from the iliac crestof the hip, as shown in FIGS. 53-56, when a shallower bone graft issufficient, the bone graft can be harvested from another bone, such asthe fibula, as shown in FIGS. 62 and 63.

FIGS. 62 and 63 show mandible model 6000 with a bone graft 6082 fromfibula leg bone 6081 to repair a region 6001 with extensive damage inthe mandible model 6000 with analogs 6087 for teeth crowns 6089, wherethe analogs 6087 conform to holes 6088 in bone graft 6082, as determinedby holes 6086 in surgical guide 6085. A patient scan is the basis forthis accurate model. The first step in pre-surgical planning is tosurgically extract the damaged region of the patient's lower jaw andthen performing a segmentectomy of the lower jaw, by cutting the damagedbone into a rectangular recess, to be filled by bone graft 6082 fromfibula 6081. This is shown in FIG. 63, where teeth have been removedwhile a rectangular recess 6001 now is at the site of damaged area 6001,located between existing teeth 6014, 6014, etc. By measuring recess 6001on jaw model 6000, a minimum size for a fibula bone graft 6082 isobtained. The actual bone harvested must be larger in all dimensions toallow for fixturing in the damaged bone of the patient, such as themandible, during the shaping process which is performed usingsubtractive methods such as milling, grinding, and possibly routing ofthe damaged area in the patient's jaw.

FIG. 62 shows fibula 6081 with a cutting guide 6085 to be bonded tofibula 6081. Note that guide 6085 is dimensioned to obtain a bone graft6082 that is slightly larger damaged region 6001 analogous to thepatient's jaw.

Before the model fibula bone graft 6082 is harvested, it is scanned sothat an accurate model in a different biocompatible material can belater made preferably by a 3D printing technique. The material can be aresin or even a sintered metal. This is done before the model harvestedbone graft is shaped to fit jaw recess 6013. Using autogenous boneeliminates a large number of possible tissue rejection problems. Also,with an autogenous bone graft in an actual jaw, osseointegration ispromoted to bond the graft 6082 and mandible 6000 intimately. Teethanalogs 6087 are used to locate replacements for damaged teeth withimplant crowns 6089, respectively. Four analogs 6087 are shown to locateteeth that were completely destroyed by trauma and must now be replacedin bone graft 6082. Surgical guide 6085 has analog alignment holes 6086for holes 6088 in bone graft 6082 to be used in the actual surgery toguide drilling of holes for posts.

The actual surgery commences with the bone harvesting (using cuttingguide 6085) from the fibula first.

The harvested bone is then shaped identically to the model bone graft6082 in the model prior to the start of the mandible surgery. Thensegmentectomy as on the model will then be surgically performed on themandible. Actual bone graft 6082 is then attached using a titanium plateidentical in size and shape to model 6082. Then, using surgical guide6085, the four post holes for analogs 6087 are accurately drilled in thejaw bone or bone graft as required.

In the foregoing description, certain terms and visual depictions areused to illustrate the preferred embodiment. However, no unnecessarylimitations are to be construed by the terms used or illustrationsdepicted, beyond what is shown in the prior art, since the terms andillustrations are exemplary only, and are not meant to limit the scopeof the present invention.

It is further known that other modifications may be made to the presentinvention without departing from the scope of the invention, as noted inthe appended Claims.

I claim:
 1. A method for pre-surgical planning for reconstruction of thecranium, jaw, limbs and digits of a patient with a prosthesis attachableto the cranium, jaw, limbs or digits of the patient with one or moreattachment members comprising the steps of: a. preparing a physicalanatomical model made in a stereographic machine that is controlled by acomputer; said computer using medical images of the patient forpreparation of the physical anatomical model by the stereographicmachine; b. determining a locational position and orientation for asurgical bone implant to repair missing bone in the cranium, jaw, limbsor digits of the patient, to install an ear prosthesis, an eyeprostheses, a nose prostheses, a limb prosthesis or a digit prosthesis;c. using the physical anatomical model and preparing a surgical guidewith oversize holes in registration with respective analogs for theattachment members securing surgical bone and cartilage implants to beinserted to the cranium, jaw, limbs or digits of the patient at thelocational positions and orientations determined by a surgeon for thephysical anatomical model, each said analog being an elongatedstructural member having at least one anti-rotational projectionextending from said elongated structural member; d. fitting saidsurgical guide atop each said elongated analog structural member, andbonding a respective surgical guide sleeve for said surgical guide tothe physical anatomical model at a locational position and orientationof the analog in the physical anatomical model, and; e. removing saidsurgical guide attached for accurate drilling during the surgicalprocedure for insertion of the bone and cartilage implants onto theskull or jaw of patient at a location analogous to said location andorientation of said analog in said physical anatomical model.
 2. Themethod for pre-surgical planning for reconstruction of the cranium, jaw,limbs and digits as in claim 1 wherein said at least one anti-rotationalprojection extends radially from said analog pin.
 3. The method forpre-surgical planning for reconstruction of the cranium, jaw, limbs anddigits as in claim 1 wherein said at least one anti-rotationalprojection extends parallel to an axial length of said analog pin. 4.The method for pre-surgical planning for reconstruction of the cranium,jaw, limbs and digits as in claim 1 wherein said surgical guidecomprises an assembly of: said surgical guide sleeve supported by aform-fitting open support mount mountable over an anatomical structure,an adapter to adjust the height of said surgical guide sleeve above theanalog, and a screw threaded through said surgical guide sleeve, saidform-fitting open support mount and said adapter from the top to securethe said surgical guide assembly to said analog below.
 5. The method forpre-surgical planning for reconstruction of the cranium, jaw, limbs anddigits as in claim 1 wherein said computer generated model is producedby the fabrication of a solid object by at least one additive methodselected from the group consisting of stereolithography, laminatedobject manufacturing, solid freeform fabrication, and fused depositionmodeling.
 6. The method for pre-surgical planning for reconstruction ofthe cranium, jaw, limbs and digits as in claim 1 wherein a threedimensional shape of said computer generated skull model made in saidstereographic machine is determined by computer CAD design.
 7. Themethod for pre-surgical planning for reconstruction of the cranium, jaw,limbs and digits as in claim 1 wherein a three-dimensional shape of saidcomputer generated skull model made in said stereographic machine isdetermined by medical images.
 8. The method for pre-surgical planningfor reconstruction of the cranium, jaw, limbs and digits as in claim 1wherein said medical images are selected from the group consisting ofx-rays, sonograms, CT Scans, nuclear imaging and magnetic resonance MRIimaging.
 9. The method for pre-surgical planning for reconstruction ofthe cranium, jaw, limbs and digits as in claim 1 wherein said surgicalguide is placed over a donor bone graft site harvested from the patientor from a cadaver, which is implanted to repair bone or cartilagedamaged by trauma, infection, disease or surgery in a different part ofthe body.
 10. The method for pre-surgical planning for reconstruction ofthe cranium, jaw, limbs and digits as in claim 9 wherein bone isharvested from a donor site in the body of a patient and threedimensional models are made of both the donor site and of the receptorsite in the body of the patient, wherein said models are used to planrespective coordinated surgeries at said donor bone graft site and saidreceptor site to create said surgical guides for precise prostheses fitand joining by attachment members or with surgical screws/pins.
 11. Themethod for pre-surgical planning for reconstruction of the cranium, jaw,limbs and digits as in claim 10 wherein said prostheses is a portion ofa skull jaw with dental implants.
 12. The method for pre-surgicalplanning for reconstruction of the cranium, jaw, limbs and digits as inclaim 10 wherein said prostheses is selected from the group consistingof a nose, an eye, an ear and a finger digit portion.
 13. The method forpre-surgical planning for reconstruction of the cranium, jaw, limbs anddigits as in claim 10 wherein said prostheses is a removable memberremovable for sanitary cleaning, said removable member attached to apermanently implanted frame, said removable prostheses attachable byattachment members to said permanently attached frame.
 14. The methodfor pre-surgical planning for reconstruction of the cranium, jaw, limbsand digits as in claim 10 wherein said prostheses is a knee replacementstructure attachable by insertion attachment members implanted into abone of a leg.
 15. The method for pre-surgical planning forreconstruction of the cranium, jaw, limbs and digits as in claim 10wherein said prostheses is a hip replacement structure attachable byinsertion attachment members implanted into a bone of a pelvic region ofthe body.
 16. The method for pre-surgical planning for reconstruction ofthe cranium, jaw, limbs and digits as in claim 10 wherein saidprostheses is a plate attachable to a fractured bone and attached tosaid fractured bone by insertion attachment members implanted into abone of a pelvic region of the body.
 17. The method for pre-surgicalplanning for reconstruction of the cranium, jaw, limbs and digits as inclaim 10 wherein said prostheses is a bone graft from a donor bone torepair a region with extensive damage in the mandible, furthercomprising the steps of wherein said model is used with analogs forteeth crowns, where positioning of said analogs conform to holes in saidin bone graft, as determined by holes in said surgical guide, whereinfurther the damaged region of the patient's lower jaw is surgicallyextracted and then a segmentectomy is performed of the lower jaw, bycutting the damaged bone into a predetermined carved out recess, to befilled by said bone graft from said donor bone site, wherein furthershaping of said recess is performed using subtractive methods of thedamaged area in the patient's jaw, wherein further, before said donorbone graft is harvested, it is scanned so that an accurate model in adifferent biocompatible material can be later made by a 3D printingtechnique, wherein further autogenous bone is used to reduce tissuerejection problems, wherein further after said autogenous bone graft isplaced in the repaired jaw, osseointegration is promoted to bond thedonor bone graft and the repaired mandible intimately, wherein furtherteeth analogs are used to locate replacements for damaged teeth withimplant crowns, respectively.